Triage Flashcards
Define the term Triage
Triage is the process of prioritising sick and injured animals, according to the severity of the illness or injury. If a patient has multiple injuries, the most serious problem is addressed first
What’s the first step of triage?
Telephone triage - calm owner, direct questioning
Client details
Why?
When did it start and how did it progress?
Has it happened before?
Medications currently and when was last dose?
Animals demeanour?
Vomit or diarrhoea? What does it look like/ how frequent?
Consciousness?
Wounds? Where and how large?
Can it urinate?
What conditions need to be immediately evaluated by a veterinary surgeon?
Unconsciousness Seizures RTA Profuse haemorrhage Respiratory distress Dysuria Trauma Unusual behaviour Pain Toxin ingestion Frequent v+/d+ with blood
How do owners get to the vets?
It is the owners responsibility to have access to transport in the event of an emergency
Advice should be given regarding transport if special precautions need to be taken eg spinals
Warn against toxin contamination/fear or pain aggression
Always ensure owner is aware of address and practice contact details
How long should the primary survey take?
60-90 seconds
What does the primary survey involve?
Respiratory
Cardiovascular
Neurological
Temperature
Assess no other systems are affected including urinary
What has to be considered in a male cat with vague presenting signs?
Urethral obstruction
What presenting signs may a cat with urethral obstruction have?
Hiding
Lethargy
Inappetance
Straining to urinate may go unnoticed by owner
What patient details need to taken?
Name Age Sex Breed Neutering status Vaccination status Medical/surgical history Current problems Current medication
What does the cardiovascular examination assess?
The cardiovascular system examination enables assessment of the haemodynamic stability of a patient.
Blood flow to body tissues (perfusion) is vital to supply sufficient oxygen for normal cellular activity and therefore patient survival.
What is me tat ion dependent on?
Appropriate blood flow to the brain
What are the levels of consciousness?
Normal
Depressed - not appropriately responsive to stimuli
Obtunded - decreased consciousness but rousable with non-noxious stimuli
Stuporous - unconscious but rousable with noxious stimuli
Comatose- not responsive to noxious stimuli
Hyperexciteable - excessive reaction to stimuli
What do pale mms suggest
Anaemia
Hypoperfusion usually caused by hypovolaemia leading to peripheral vasoconstriction
What do yellow mms suggest
Icterus/jaundice
Liver dx, excessive haemolysis, biliary tract dx
What do bright red mms suggest
Early sepsis/ SIRS in dogs
What do blue/ purple mms suggest
Cyanosis
Severe hypoxaemia
Secondary to deoxygenated haemoglobin
What do brick red mms suggest
Carbon monoxide poisoning
What do brown mms suggest
Paracetamol toxicity (methaemaglobinaemia)
What do tacky or dry mms suggest
Dehydration
Does not necessarily mean hypovolaemia
What does the CRT mean?
Amount of time for the blood to return back to the capillary bed after being forced out by digital pressure
What does prolonged crt suggest
> 2 secs
Hypoperfusion / shock if mms also pale
What does rapid crt suggest?
Sepsis
Define the term shock
Lack of oxygen delivery to cells/ tissues. Decreased cell oxygenation causes organ dysfunction and cell death.
If untreated, this will result in multiple organ dysfunction (MOD) and patient death.
What heart rate is classed as tachycardia in dogs?
140bpm but dog dependant
A constant tachycardia is less worrying than an irregular tachycardia
What is a common cause of tachycardia?
Hypoperfusion/ shock
What is inappropriate bradycardia?
When a heart rate is normal where tachycardia is expected eg hypovolaemic shock
What can cause bradycardia?
Hyperkalaemia Drugs eg lidocaine Increased vagal tone Atrioventricular block Hypothermia Sick sinus syndrome Raised intracranial pressure
Causes of tachycardia in cats
Hyperthyroidism Congestive heart failure Intoxications Electrolyte disturbances Pain Stress
Causes of bradycardia in cats
Septic shock Sepsis Hyperkalaemia (urethral obstruction) Hypothermia High vagal tone
